Oy. As a DON in Ohio.....a few things come to mind.....firstly yes you have a voice and CAN professionally express your concerns about an assignment that superman could not physically do: You are doing nothing wrong when you professionally voice your concerns to your supervisor: There is no policy or law against that. You have to protect your license and the residents: If your concerns are not addressed then you should contact the administrator and so on: Noone would want to work like that and it is not fair to the residents either. Everyone has a supervisor: and if your concerns are not being addressed properly or you fear retaliation then by all means go to someone else....mainly the admin is the next step up. As the DON it is our job to ensure that there is adequate staffing to ensure the care is being done: Why in the world your DON would be on call and 600 miles away makes little sense: Don't go out of town if you are on call: So that mistake is on her.....but even being out of state.....did she assist in contacting other staff to assist? Is there an ADON? She should not have just left it like that without attempting to assist in calling to find coverage. Talk to your administrator professionally about your concerns.......approach it not as if you are condemning the DON ....but go prepared to discuss concerns at a resident care level. Also don't just bring the problems...you should also have in mind a few solutions that you think may work to solve the problems too.....be as positive as you can and help be a part of the solution....maybe after you could suggest a meeting with the DON with the admin present to further discuss the issues.
Ultimately as a licensed nurse your obligation is to notify a resident's physician of a change in condition: it is acceptable to also notify the DON of the issue and the MD response- if this is her preference but first and foremost the MD should be contacted first and treatment initiated. No of course we don't wish to send every UTI to the ER-esp if we can successfully treat these in the facility: that is why your assessment skills and communication to the physician is key: As a DON we can try and assist nurses in suggesting treatment that are the standards of care-or with our experiences in nursing things that have been successful in the past to suggest to the physician-but ultimately it is the physician who orders the care not the nurse-DON or not-. I would advise you to contact the physician first with changes of condition then your DON can be made aware of what occurred and what the physician ordered treatment plan is....but please always notify the doctor no matter who tells you differently. Cover yourself and ensure the resident is getting the care that they need.
You sound like a great, caring nurse....one that LTC needs. Don't give up on a job that you like and working with residents you obviously care about without seeing if there are ways in which you can improve things for yourself and for the whole facility. (: